Author ORCID Identifier


Date Available


Year of Publication


Degree Name

Doctor of Nursing Practice

Committee Chair

Dr. Misty Ellis

Clinical Mentor

Dr. Adrienne Johnston

Committee Member

Dr. Holly Chitwood

Committee Member

Dr. Jennifer Dent




Conversations between care providers and patients are integral to medicine and are the most performed “procedure” (Luff et al., 2016). In Pediatric Intensive Care Units (PICUs) and Pediatric Cardiac Intensive Care Units (PCICUs), children of all ages with diverse diagnoses and needs are treated for critical illnesses and traumatic events. Therefore, providers frequently have difficult conversations with patients and their families. Pediatric critical care nurses are often invited to participate in these discussions. However, their role during, and after, these conversations is not always clear. The goal of this project was to evaluate the impact of an educational simulation-based intervention on the knowledge and comfort level of pediatric critical care nurses regarding difficult conversations with patients and their families.


This project was a quasi-experimental study with a one group pre-test-post-test design. A total of 55 pediatric critical care nurses were eligible and invited to participate. Participants completed a pre-test survey that provided demographics as well as established baseline knowledge and comfort level regarding difficult conversations. Participants then listened to a 10-minute voiceover PowerPoint presentation regarding difficult conversations, the critical care nursing role and framework to utilize when having a difficult conversation with a patient or family. This was followed by a simulation experience where participants could apply their new knowledge with a parent actor. The simulation was followed by a debrief opportunity and finally participants completed a post-test survey. Data was analyzed utilizing descriptive statistics, and paired t-tests on Statistical Package for the Social Sciences (SPSS) software.


A total of 26 nurses completed the pre-test survey, voiceover PowerPoint, simulation, debrief and post-test survey. There was a statistically significant increase in knowledge of the nursing role in difficult conversations as well as the individual’s comfort level in having such conversations.


The aim of this project was to develop an educational program that included simulation to teach current pediatric critical care nurses about difficult conversations, their role in these conversations and improve their confidence. This project was successful in doing so and demonstrated statistically significant improvement in knowledge and confidence. This project has the potential to dramatically improve the patient/family experience during difficult conversations and involvement in care.